A randomized controlled trial of coil removal prior to treatment of pelvic in¯ammatory disease Sabahattin Altunyurt * , Namik Demir, Cemal Posaci Departmentof Obstetrics and Gynecology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey Received 20 January 2002; received in revised form 19 July 2002; accepted 16 August 2002 Abstract Objective: To evaluate the effects of removing coils on the treatment of mild and moderate pelvic in¯ammatory disease (PID). Methods: Of 126 women who had mild to moderate PID during coil usage, 60 were treated following coil removal and 66 without. Clinical symptoms, ®ndings of gynecologic examination, erythrocyte sedimentation rates (mm/h), leukocyte counts (mm 3 ) were recorded before and after treatment and recovery rates of symptoms and ®ndings were compared with Chi-square and Fisher's absolute Chi-square tests. Student's t-test was used for the comparison of mean sedimentation rates and leukocyte counts. Results: Recovery rates of pelvic pain, purulent vaginal discharge, dysuria/frequency and dyspareunia and clinical improvements in abdominal and cervical tenderness were signi®cantly higher (P < 0:05) in the coil removed group. Conclusions: Removing the coil before medical therapy, increases the rates of clinical improvement in mild to moderate PID. # 2002 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Pelvic in¯ammatory disease; Coil; Therapy 1. Introduction Pelvic in¯ammatory disease (PID) or salpingitis includes acute, sub-acute, recurrent and chronic infection of the uterus, oviducts and ovaries, often with involvement of adjacent tissues [1]. An important sequelae is infertility associated with tubal occlusion which may affect 25% of all cases [1,2]. It usually develops as an ascending infection of patho- genic microorganisms through the cervix from vagina to upper genital organs [3]. The commonest responsible micro- organisms are Neisseria gonorrhoea and Chlamydia tracho- matis [1,4]. Early sexual intercourse, multiple sexual partners and coil usage are risk factors [5]. The coil is especially a predisposing factor in the ®rst few months after insertion [6]. In 22,908 coil users, PID risk was six times greater during the 20 days following insertion of coil compared with subsequently when it was similar with the normal population [6]. The usual management when PID is diagnosed in a coil user is to apply medical therapy after the removal of coil [7]. Barrier contraceptive methods (e.g. diaphragm, condom) and oral contraceptives (by thickening cervical mucous) are reported to decrease PID risk [5,8,9]. 2. Materials and methods Total of 138 women with clinically diagnosed mild and moderate PID were included. Patients with severe PID (peritoneal irritation, rebound tenderness, abdominal rigid- ity or clinical and hematological instability) were excluded and treated with coil removal. Clinical symptoms, ®ndings of gynecologic examination, erythrocyte sedimentation rates (ESR) (mm/h) and leuko- cyte counts (mm 3 ) of all patients were recorded before treatment. The presence of pelvic pain (recent onset, lower abdominal pain), vaginal discharge (recent onset vaginal discharge with abnormal smell and color), dysuria/fre- quency, nausea/vomiting, vaginal bleeding (inter-menstrual bleeding) and dyspareunia (recent onset) were detected from the history of patients. The presence of abdominal tenderness, purulent cervical discharge, cervical tender- ness (dislocation pain) was determined with physical and European Journal of Obstetrics & Gynecology and Reproductive Biology 107 (2003) 81±84 * Corresponding author. Tel.: 90-232-2777777x3152; fax: 90-232-2781581. E-mail address: s.altunyurt@deu.edu.tr (S. Altunyurt). 0301-2115/02/$ ± see front matter # 2002 Elsevier Science Ireland Ltd. All rights reserved. PII:S0301-2115(02)00342-1